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Rheumatic disease activity, glucocorticoid use and COVID-19. Response to: ‘Comment on ‘Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry’ by Gianfrancesco et al. Disease activity, rather than glucocorticoid therapy, may be associated with COVID-19 severity in patients with rheumatic musculoskeletal diseases’ by Giollo et al
  1. Kimme L Hyrich1,
  2. Milena Gianfrancesco2,
  3. Pedro M Machado3,4,
  4. Jinoos Yazdany5,
  5. Philip C Robinson6,7
  1. 1Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
  2. 2Department of Medicine, Division of Rheumatology, University of California, San Francisco, San Francisco, California, USA
  3. 3MRC Centre for Neuromuscular Diseases, University College London, London, UK
  4. 4Rheumatology, University College London Centre for Rheumatology, London, UK
  5. 5Medicine/Rheumatology, University of California, San Francisco, California, USA
  6. 6Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  7. 7Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
  1. Correspondence to Dr Philip C Robinson, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia; philip.robinson{at}

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We thank Giollo and colleagues for their correspondence acknowledging the challenges of understanding those risk factors which contribute to severe outcomes in patients with underlying rheumatic musculoskeletal diseases (RMDs) who acquire the novel SARS-CoV‐2 infection.1 In their short case series, they highlight the balance and relative importance between disease activity and dose of glucocorticoid therapy, two factors which are highly linked within an individual. It is already known that both disease activity and glucocorticoid dose are independent risk factors for serious infection in patients with RMD, such as rheumatoid arthritis and systemic lupus erythematosus,2–4 as are age, the underlying RMD diagnosis itself and the presence of other comorbidities. Disentangling the individual contribution of any of these individual risk factors will require robust analysis of large and diverse patient datasets. The Global Rheumatology Alliance (GRA)5 aims to capture cases of COVID-19 among patients with pre-existing RMD and is reliant on the nature and diversity of the individual cases reported in order to provide a greater understanding of individual risk. By leveraging such a large dataset, we are able to conduct multivariable analyses that control for a number of different factors to estimate the contribution of individual risk factors. Future analyses of the GRA and other large patient registries will hopefully provide further insight into individual risk factors for severe outcomes in this patient group, such that we can offer the most relevant evidence to our colleagues and patients.



  • Handling editor Josef S Smolen

  • Twitter @pedrommcmachado, @philipcrobinson

  • Contributors KLH drafted the first version. All authors revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests KLH reports she has received speaker’s fees from Abbvie and grant income from BMS, UCB and Pfizer, all unrelated to this article. KLH is also supported by the NIHR Manchester Biomedical Research Centre. MG reports grants from National Institutes of Health, NIAMS, outside the submitted work. JY reports personal fees from Astra Zeneca and Eli Lilly, and grants from Pfizer, outside the submitted work. PMM reports personal fees from Abbvie, Eli Lilly, Novartis and UCB, outside the submitted work. PCR reports personal fees from Abbvie, Eli Lilly, Janssen, Pfizer, UCB and Novartis; and non-financial support from BMS and Roche outside the submitted work.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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